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Biomedical subjects

J E Fulton

Publications and source records attributed to J E Fulton.

At least 19 recordsLinked to original sources

Physical activity, food choice, and weight management goals and practices among US college students.

INTRODUCTION: Physical activity and a healthy diet have been recommended to help reverse the increasing prevalence of overweight among adolescents and adults in the United States. METHODS: Data is from the 1995 National College Health Risk Behavior Survey. A representative sample of US undergraduate college students (n = 4609) were analyzed to examine associations of physical activity and food choice with weight management goals and practices. RESULTS: Based on self-reported height and weight, 35% of students were overweight or obese (body mass index > or = 25.0). Nearly half (46%) of all students reported they were trying to lose weight. Female students were less likely than male students to be overweight, but more likely to be trying to lose weight. Among female and male students, using logistic regression to control for demographics, trying to lose weight was associated with participation in vigorous physical activity and strengthening exercises, and consumption of < or = 2 servings/ day of high-fat foods. Female and male students who reported using exercise to lose weight or to keep from gaining weight were more likely than those who did not to participate in vigorous, strengthening, and moderate physical activity, and were more likely to eat > or = 5 servings/day of fruits and vegetables and < or = 2 servings/day of high-fat foods. Among students who were trying to lose weight, only 54% of females and 41% of males used both exercise and diet for weight control. CONCLUSION: Colleges should implement programs to increase student awareness of healthy weight management methods and the importance of physical activity combined with a healthy diet.

Adult↗

Lip rejuvenation.

BACKGROUND: The management of the senile lip remains a dilemma. Allogenic fillers often feel unnatural, lip resurfacing is not adequate, and fat transfers may disappear. OBJECTIVE: To develop a more reliable step-by-step approach to lip augmentation. METHOD: Lips were divided into types: (1) the simple senile lip that had lost its fullness-treated with fat augmentation; (2) the lip with rhagades-treated with fat augmentation and laser resurfacing; and (3) the duckbill lip-treated with lip advancement, fat augmentation, and laser resurfacing. Tattooing to increase the degree of redness was performed on all types of lips. RESULT: If there had been a previously full lip, it was possible to rejuvenate the lip by simple augmentation with autologous fat transfer. The average number of fat transfer sessions to generate this pleasing lip was two to three. The lip with rhagades required fat filling, with laser resurfacing to achieve a new contour. The duckbill lip required a lip advancement along with lipofilling and laser resurfacing. All types benefited from lip tattooing. CONCLUSIONS: It was possible with fat augmentation and/or laser resurfacing to generate a pleasing lip in type 1 and 2 lips. Lip type 3 required a lip advancement along with fat augmentation and laser resurfacing. Lip tattooing accentuated all the lip types.

Adipose Tissue↗

CO2 laser physics and tissue interactions in skin.

BACKGROUND AND OBJECTIVES: The theoretical model of CO2 laser tissue interaction appeared to be too simplistic. To explain the reactions seen in skin, a more complex model was needed. We hoped to correlate the clinical-histologic patterns of CO2 laser tissue interactions. STUDY DESIGN/MATERIALS AND METHODS: The Ultrapulse CO2 laser was used on normal and pathologic skin conditions. Clinical observations were correlated with histologic examinations of biopsies. RESULTS: It was possible to demonstrate cavitation at the dermal-epidermal junction 2-3 diameters beyond the actual spot of CO2 laser contact with the skin. Dermal heat damage was seen as homogenization of collagen 1-2 diameters beyond the spot of laser contact. This flow of energy laterally at the dermal-epidermal junction and vertically down the skin follicles was both clinically beneficial and detrimental. Beneficially, superficial skin lesions separated at this junction and were easily removed. The heat coagulation of the dermis facilitated lesion removal without bleeding. The clinician had a better view of the pathology and could find focal zones of deeper pathology that could be easily re-treated. Detrimentally, this extended damage delayed wound healing and led to persistent erythema. CONCLUSION: These clinical-histologic correlations have provided a better understanding of CO2 laser tissue interactions in skin. It has been possible to take advantage of these findings to remove pathologic skin conditions more efficiently.

Biopsy↗

Apolipoprotein E affects serial changes in total and low-density lipoprotein cholesterol in adolescent girls: Project HeartBeat!

Apolipoprotein E (apo E) polymorphism is a genetic determinant of lipid and lipoprotein levels and the risk for coronary heart disease. The extent to which serial patterns of change in total cholesterol and low-density lipoprotein cholesterol (LDL-C) concentrations varied by apo E genotype was therefore investigated in 247 Caucasian girls aged 8 to 14 at baseline who were participating in Project HeartBeat!, a mixed longitudinal study of cardiovascular disease (CVD) risk factor development in children. Plasma lipid concentrations were determined for each participant three times per year (every 4 months) for up to 4 years from October 1991 through August 1995. Mean total cholesterol values for individuals with epsilon2/3, epsilon3/3, and epsilon3/4 genotypes were 141.7, 161.6, and 165.9 mg/dL, respectively (P < .001). Corresponding LDL-C values for individuals with epsilon2/3, epsilon3/3, and epsilon3/4 genotypes were 74.6, 94.8, and 98.7 mg/dL, respectively (P < .001). The results of longitudinal modeling indicated that age trajectories for total cholesterol and LDL-C varied significantly by apo E genotype. Individuals with epsilon3/3 and epsilon3/4 genotypes exhibited similar patterns of change in total cholesterol and LDL-C from ages 8 to 18, while individuals with the epsilon2/3 genotype demonstrated a significantly different pattern of change (age2 x genotype interaction, P < .05). For example, individuals with the epsilon2/3 genotype showed a slight increase in total cholesterol from approximately 141 to 146 mg/dL from ages 8 to 10; total cholesterol then decreased monotonically from ages 10 to 18 from 146 to 115 mg/dL. The apo E effect on total cholesterol and LDL-C and their change during adolescence is strong and may be modified by factors affecting growth, maturation, and reproductive function.

Adolescent↗

Resurfacing the acne-scarred face.

BACKGROUND: : Dermabrasion has been a useful method for the improvement of acne scars since 1953. However, the improvement is often limited. Adjuvant procedures are often necessary to improve results. OBJECTIVE: : To improve the results of resurfacing the acne scarred face. By combining the techniques of subcutaneous filling, laser shrinkage of collagen, dermabrasion, and excision, we hope to achieve better results. METHODS: A Jessner/TCA peel is performed on the neck and décolleté area after the skin has been preconditioned with vitamin A conditioning lotions. The acne scars are subcised with a semi-blunt needle, and the developed pockets are filled with adipose tissue. Following this, the surface skin is vaporized with three passes of the CO2 laser, and the deeper acne scars in the mid-face region are sanded with a diamond fraise. Residual scars are excised and sutured. A semi-occlusive dressing is used for 5 days, then replaced with an ointment-based moisturizer. After 10 days, a moisturizer-sunscreen is used, followed with a bleaching cream at 15 days. Make-up may be applied after 14 days. CONCLUSION: : By combining these multiple modalities it is possible to produce a dramatic improvement of the acne-scarred complexion.

Acne Vulgaris↗

Sleep lines.

BACKGROUND: This is a tribute to Dr. Samuel J. Stegman who in 1987 described "Sleep Creases." His awareness of these lines has helped us understand the anatomy of the underlying superficial musculoaponeurotic system (SMAS). OBJECTIVE: To expand upon the clinical description and the anatomical basis of sleep lines. METHOD: A pillow or hand test is used to accentuate sleep lines. Their development is linked to the underlying attachments of the SMAS. RESULTS: There is a correlation between the location of the underlying SMAS or aberrant scar tissue and sleep lines. To effectively treat these lines, the sleeping position must be altered or subcision of the underlying SMAS attachments and skin resurfacing may improve the situation. CONCLUSION: We have confirmed Dr. Stegman's hallmark work on sleep wrinkles. They are accentuated by pillow contact and the underlying SMAS.

Face↗

Neck rejuvenation by combining Jessner/TCA peel, dermasanding, and CO2 laser resurfacing.

BACKGROUND: One of the greatest challenges facing facial cosmetic surgeons today is the simultaneous rejuvenation of the neck and face. Laser resurfacing of the face using the carbon dioxide (CO2) laser or the erbium:yttrium-aluminum-garnet (Er:YAG) laser has enjoyed widespread popularity, but the neck and chest are often avoided. It would be quite helpful to rejuvenate the neck at the same time the face is being resurfaced. This would diminish lines of demarcation and help reduce the signs of aging of the neck. There would be a better match between the new skin of the neck and face. OBJECTIVE: To develop a safe and effective method to rejuvenate the neck. METHOD: A step-by-step skin care program was instituted. The patients preconditioned their face and neck skin with vitamin A/glycolic skin conditioning lotions for 6-8 weeks prior to surgery. Following this the chest and neck area was treated with the Jessner-trichloroacetic acid (TCA) peel. Then the middle section of the neck was sanded with 150 grit sandscreen. Finally, the central area was resurfaced with the UltraPulse CO2 laser using reduced power settings. Usually two passes was adequate to shrink the skin of this central section of the neck. A petrolatum-based ointment was applied during the initial 7-day postoperative period. After reepithelialization a sunscreen-moisturizer was used during the day and hydrocortisone moisturizer was applied at night. RESULTS: The neck skin was able to tolerate this step-by-step skin rejuvenation. The blending from the décolleté area to the hairline produced a rejuvenation without a line of demarcation. There were no examples of scarring in the 12 cases that were evaluated for 6 months. Two cases developed persistent erythema that responded to silicone gel sheeting. Although no patients complained of hypopigmentation, a decrease in pigment was found using special UV photography. CONCLUSION: It is possible with this gradient, step-by-step method to produce a rejuvenation of the neck. An improved texture of the neck developed without visible scarring.

Chemexfoliation↗

The complications of blepharoplasty: their identification and management.

BACKGROUND: Because of the increasing number of blepharoplasties being done by cosmetic dermatologists, it is necessary to have an increased awareness of sequella and complications. OBJECTIVE: To review the frequent complications following blepharoplasty and to develop methods for their prevention and treatment. METHOD: A thorough history and physical combined with accurate intraoperative markings and postoperative instructions can make the procedure more predictable. CONCLUSION: Armed with an awareness of possible blepharoplasty complications, an adequate history and physical can point to areas of concern. If these guidelines are observed, a blepharoplasty can be completed that keeps both the physician and patient satisfied.

Blepharoplasty↗

Modified tumescent liposuction.

BACKGROUND: Tumescent liposuction has been found to be safe and effective. However, there are still many refinements that may be possible, such as varying the size and tips of the cannulas, varying the types of infiltrate and associated anesthesia, and the method of compression. OBJECTIVE: To examine possible variables in tumescent liposuction techniques such as the most efficient liposuction cannulas, to determine an effective tumescent fluid, and to examine the extent of compression provided by different garments. METHODS: Patient markings, tumescent fluid formulas, methods of infiltration, types of cannulas, skin incisions, and compression garments were compared between the pure tumescent technique and modified tumescent liposuction. RESULTS: The most efficient cannulas were those with three staggered ports, such as the Mercedes, Cobra-keel, Giorgio Fischer, and Accelerator II tips. When these are combined with modified tumescent fluids and sedation, it is possible to perform total body liposuction in a safe and efficient manner. Multiple ports and compression garments are beneficial to reduce bruising and focal areas of inflammation. CONCLUSION: The tumescent liposuction technique will continue to be improved. So far, with more efficient cannulas and more efficient tumescent fluids, combined with sedation, it has been possible to increase the yield and decrease the required time for the technique. We call this modified tumescent liposuction.

Humans↗

Dermabrasion using CO2 dry ice.

BACKGROUND: The cosmetic dermatologic surgeon can improve facial scars by using a variety of techniques. Chemical peels, lasers, and dermabrasion are among the most common modalities used. In recent years, laser resurfacing has enjoyed great popularity; however, there is still a role for the time-honored and effective technique of dermabrasion. The recent withdrawal of Freon from the market has made dermabrasion more difficult. OBJECTIVE: To introduce a novel technique of using solid carbon dioxide (CO2) to freeze the skin before dermabrasion. METHOD: Twenty-five consecutive patients with facial acne scars underwent a combination of procedures including chemical peeling and CO2 laser resurfacing, followed by freeze-dermabrasion. Compressed CO2 was then used to make a solid ball of dry ice. The ice was used to freeze the skin prior to dermabrasion. After the application of the dry ice ball to the skin for about 4 seconds, the scares were dermabraded with the large mushroom wheel. As the tissue defrosted, the operator started at the outer edge of the freeze and planed into the center. This procedure was repeated until the desired improvement was achieved. RESULTS: With dry ice, a good skin turgor was achieved. This provided a good foundation for the sanding of the acne scars. The patients were pleased with the results and complications were minimal. CONCLUSION: "Home-made" dry ice works as well as Freon in providing skin turgor for dermabrasion. CO2 dry ice has the added benefits of being inexpensive and environmentally friendly.

Adult↗

Disappointing results following resurfacing of facial skin with CO2 lasers for prophylaxis of keratoses and cancers.

BACKGROUND: With the development of the short-pulse CO2 laser it was hoped that this resurfacing would prevent recurrent actinic keratoses and basal cell cancers similar to resurfacing with dermabrasion, laser abrasion, and deep chemical peel. However, we have begun to see patients that are developing keratoses and cancers within months following laser resurfacing. OBJECTIVE: To document the problems of recurrent keratoses and basal cell cancers in patients following CO2 laser resurfacing. METHODS: Thirty-five patients with extreme sun damage were seen at 3, 6, and 12 months following CO2 laser resurfacing for repeat color and ultraviolet photography and clinical examination to look for erythematous dyskeratotic lesions or papules with pearly borders. RESULTS: Five of our patients (14.3%) who had undergone recent CO2 resurfacing developed actinic keratoses and basal cell cancers. CONCLUSION: CO2 laser resurfacing is not as effective as dermabrasion, chemabrasion, and deep chemical peel for the prophylaxis of actinic keratoses and basal cell cancers, especially in Fitzpatrick type I and II patients.

Adult↗

Detecting bouts of physical activity in a field setting.

The purposes of this study were to assess the TRITRAC and CSA for: (a) interaccelerometer agreement; (b) agreement in detecting patterns of moderate-intensity physical activity; and (c) agreement in detecting walking patterns recorded in a diary. Thirty-one women wore both the TRITRAC and CSA accelerometers for three consecutive days. Interaccelerometer agreement (measured with generalizability coefficients) ranged from .88 to .99. In total, 71.3% of the accelerometers' patterns agreed in length, with CSA patterns being on average significantly longer. Interaccelerometer agreement in detecting patterns of brisk walking, as recorded in a diary, was comparable (69.4%). Interaccelerometer discrepancies may be related in part to the threshold employed by each instrument for classifying moderate intensity patterns.

Adult↗

Analysis of polymorphisms in the major expressed class I locus (B-FIV) of the chicken.

We analyzed the polymorphic nature of eleven alleles expressed by the major class I locus (B-FIV) in chickens. Similar to mammalian class I loci, the nucleotide substitutions with high variability occur in exons 2 and 3 encoding the alpha1 and alpha2 domains. However, the nonsynonymous to synonymous ratio of nucleotide substitutions in exon 3 encoding the alpha helix and beta sheets is reversed compared with HLA. The region of exon 3 encoding the alpha2 helix demonstrates a much lower nonsynonymous to synonymous ratio, suggesting evolutionary selection of a more conserved alpha2 helix in B-FIV compared with HLA. Amino acid residues with high Wu-Kabat variability are typically located in positions predicted to impact antigen presentation. B-FIV amino acid residues predicted to interact with the CDR1alpha region of the T-cell receptor (Tcr) demonstrate less variability than in mouse and human class I alleles. The combination of a reduced nonsynonymous to synonymous ratio in exon 3 encoding the alpha2 helix and the limited variability in CDR1alpha contact residues is discussed with regard to concerted evolution between a minimal major histocompatibility complex and compaction of Tcr variable gene segments in the chicken.

Alleles↗

Measuring physical activity in midlife, older, and minority women: issues from an expert panel.

This article summarizes the findings of an exploratory meeting of 53 experts brought together under the aegis of the Women's Health Initiative to identify important issues related to measuring physical activity in minority women, women in midlife (aged 40-75), and older women (aged > 75). The findings address five areas, three dealing with measurement and two concerning the design of surveys: (1) population characteristics to consider when measuring the physical activity of women and minority populations, (2) activity dimensions relevant to physical activity surveys, (3) measuring moderate and intermittent activities, (4) designing and administering physical activity surveys for older and minority women, and (5) establishing the reliability and validity of such physical activity surveys. Although the focus of the expert panel meeting was on identifying issues related to the measurement of physical activity in women, many issues summarized here can be generalized to children and men. The panel's findings concerning measuring physical activity are timely, as they directly bear on the challenges associated with the physical activity guidelines jointly issued by the Centers for Disease Control and Prevention and the American College of Sports Medicine and the recommendations made in the Surgeon General's 1996 report, Physical Activity and Health.

Adult↗

Simultaneous face lifting and skin resurfacing.

Although face lifting and skin resurfacing both produce dramatic facial rejuvenations, the simultaneous combination has never been popularized. The development of new methods of lifting and resurfacing may now allow a reevaluation of this combination. The objective was to evaluate the safety and efficacy of this combined face lift and skin resurfacing. The facial skin was resurfaced with a trichloroacetic acid peel or a "short-pulse" CO2 laser and, then, lifted after liposuction and superficial musculoaponeurotic system tightening. A dramatic rejuvenation was produced in these 25 cases. There were no incidents of persistent erythema, pigmentation, hyperpigmentation, or full-thickness flap necrosis. Side effects were the usual sequelae of edema and ecchymoses. The small areas of "dusky" erythema of the skin flaps were no more significant than those after a face lift alone. By following the guidelines developed in this report, the combination of controlled skin resurfacing with face lifting is safe and effective. Other procedures, such as blepharoplasties, can also be added. After one recovery period of 6 to 8 weeks, these patients reported that they looked 15 to 20 years younger. The complexion continued to improve during the 1-year follow-up period.

Adult↗

Collagen shrinkage (selective dermaplasty) with the high-energy pulsed carbon dioxide laser.

BACKGROUND: The high-energy pulsed carbon dioxide (CO2) laser has proven useful for skin resurfacing. The modality can be less penetrating than chemical peels and more accurate than dermabrasion. OBJECTIVE: To demonstrate the additional benefit of dermal remodeling (selective dermaplasty) of skin lesions, scars, grafts, folds, and eyelids. METHODS: The collimated and the computerized pattern generator handpieces were used with the high-energy pulsed CO2 laser at 250-350 mJ to remodel tissue. Usually three or four passes were adequate to vaporize tissue and shrink collagen. RESULTS: A rejuvenated earlobe, eyelid, or forehead was produced in a predictable fashion. The tissue irregularities of scars, dog-ears, or trap-door deformities were reduced and remodeled. CONCLUSION: Dermal remodeling (selective dermaplasty) with the high-energy pulsed CO2 laser has proved a useful tool to remodel the skin. Areas such as the earlobe, the forehead, the eyelids, or skin lesions can be vaporized to develop a more youthful appearance. We find this a useful addition to the armamentarium of the cosmetic dermatologist.

Collagen↗

A novel occlusive dressing for skin resurfacing.

BACKGROUND: Over the last decade the benefits of occlusive dressings have been appreciated. These dressings allow the epithelium to resurface easier. The wound heals quicker. OBJECTIVE: To evaluate a new silicone sheeting for immediate post-op wound care. Our objective was to determine its benefit in the wound care management after laser skin resurfacing. METHOD: The silicone sheeting was applied immediately after laser resurfacing in 35 individuals. This temporary skin replacement was held in place with 4 x 4 gauzes and tube gauze netting. Although the tube netting and the 4 x 4 gauzes were changed daily the silicone sheeting remained in place for 4 or 5 days. Following this, applications of a petrolatum-based ointment were continued for another 5 days. At day 10 the skin care program was changed to a moisturizing sunscreen. Bleaching cream was added at day 15 in darker complexed individuals. RESULTS: The dressing accelerated wound healing. Pain and swelling were minimized under the sheeting. Histologic examinations demonstrated a more rapid reepithelialization at these treated sites. Other than technical problems, such as the riding up of the dressing over the jawline or retraction of the dressing off the lips or off the eyelids, there were no adverse sequelae. The wound healed rapidly and allowed the rapid progression to the application of a moisturizer-sunscreen or a skin-bleaching cream. Other than these technical problems there were no complications. No wound infections were noted. CONCLUSION: The use of silicone sheeting following skin resurfacing facilitated a rapid reepithelialization of treated areas. There was a remarkable reduction in erythema and edema accompanying the use of the dressing. The program made it possible for patients to return to work in 12-15 days.

Dermatologic Surgical Procedures↗

Small volume fat transfer.

BACKGROUND: The use of autologous fat has been advocated for tissue augmentation for over a century. However, this technique remains controversial and many investigators have made suggestions to increase its potential. OBJECTIVES: To develop a less traumatic method to collect, purify, and reinject fat to obtain more dramatic augmentations for the cosmetic improvement of contours and tissue defects. METHODS: Fat was collected from the donor site following tumescent infiltration of tissue. A "vented" syringe with an atraumatic Mercedes tip was used to collect the fat and, after washing with lactated Ringers or saline, the fat was transferred to small syringes for controlled injections. Small filaments of fat were placed in multi-layers throughout the area of the defect or area of desired contour change. The unused fat was frozen for a second or third injection session. RESULTS: The fat transfer method yielded augmentations of 40%-120% of injected volume in the 339 areas treated. After 45-60 days, the implant was stabilized and remained for the length of our study (up to 10 years). In several cases excessive fat had to be removed. Other than slight bruising, occasional divots at the donor site, and three cases of bacterial infection, the autologous tissue transfer was an uncomplicated event. CONCLUSION: Fat grafting has proven to be a safe and effective procedure for correcting and enhancing tissue defects and contour deficiencies.

Adipocytes↗